Provider Demographics
NPI:1073630554
Name:LY, LYNN E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:E
Last Name:LY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:E
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:137 NORTH COTTOONWOOD ST.
Mailing Address - Street 2:STE 1540
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-666-8541
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST
Practice Address - Street 2:STE 1540
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-666-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 25358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker